MEDICARE: JJS OPTICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1952745325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJS OPTICAL LLC

Provider Business Mailing Address
First Line	:	7420 E POINT DOUGLAS RD S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3025
Country	:	US
Telephone Number	:	651-459-9696
Fax Number	:	651-459-4633

Provider Business Practice Location Address
First Line	:	7420 E POINT DOUGLAS RD S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3025
Country	:	US
Telephone Number	:	651-459-9696
Fax Number	:	651-459-4633

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES E JOHNSON
Credential	:
Telephone Number	:	612-963-8886

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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Directions to “JJS OPTICAL LLC ” Practice Location

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